As the core agricultural area in the tropical and subtropical regions, China’s red soil area accounts for 30% of the country’s agricultural land. However, due to industrial production (including mining, smelting, chemical manufacturing, etc.), agricultural activities, and a high geochemical background, it has become a concentration area for heavy metal pollution such as cadmium (Cd), arsenic (As), lead (Pb), copper (Cu), zinc (Zn), chromium (Cr) and mercury (Hg). The strong acidity (pH<5.5), low organic matter content (<20 g/kg), and redox alternation of red soil significantly enhance the bioavailability of heavy metals, leading to the increased risk of soil-crop-food chain migration and threatening food security and human health. In this paper, we systematically reviewed the characteristics of the “industry-led and agriculture-overlapping” sources of heavy metal pollution in the red soil area. It was found that cadmium (Cd), arsenic (As), and lead (Pb) contamination are particularly severe, and the heavy metal concentrations are higher in the east and lower in the west. We revealed the key interfacial processes, such as the dynamic transformation of iron and aluminum oxides and the insufficient complexation capacity of organic matter under the multi-metal composite pollution, and evaluated the applicability of remediation technologies, such as water management, passivation improvement, and phytoremediation in red soil. Furthermore, we identified the challenges in heavy metal remediation within red soil regions, including significant pressure for source control, widespread multi-metal complex contamination, and poor long-term efficacy of passivators. In the future, to provide theoretical foundations and practical paths for the realization of high-quality agricultural production and ecological safety in the red soil regions, it’s necessary to develop specific materials such as functionalized/modified passivation materials, establish an intelligent pollution risk monitoring and predictive modeling system, and form a whole chain management system of “source blocking control-process blocking-end management”.